Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02360 | Date 27/06/2019 |
| Token No | SM/18-19/5636 16/08/2019 | Serial | 004 |
| Patient Name | Mr. BIJAY KUMAR SHA | Contact No | 8334825772 |
| Address | 10 DEY STREET | Age | 22 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||